Lawmakers push back against state cuts to ambulance rates

Paramedics wheel an injured person to an ambulance after a four-vehicle crash on the Northeast Side. The San Antonio Fire Department could lose about $600,000 yearly under the proposal.

Paramedics wheel an injured person to an ambulance after a four-vehicle crash on the Northeast Side. The San Antonio Fire Department could lose about $600,000 yearly under the proposal.

Photo: San Antonio Express-News / File Photo

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San Antonio EMS paramedics prepare to transport an accident victim Monday December 15, 2014 to an area hospital after she rolled her Mazda SUV off of an embankment at the intersection of Wurzbach Parkway and Wetmore road at about 8:30 a.m. . Traffic on the ramp was blocked for about a half hour and a firefighter at the scene said the victim's injuries were non-life threatening. less

San Antonio EMS paramedics prepare to transport an accident victim Monday December 15, 2014 to an area hospital after she rolled her Mazda SUV off of an embankment at the intersection of Wurzbach Parkway and ... more

Photo: JOHN DAVENPORT, STAFF / San Antonio Express-News

Lawmakers push back against state cuts to ambulance rates

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AUSTIN — Ambulance providers are fighting a payment cut proposed by the state, warning it could decimate service in rural areas and put pressure on local taxpayers to make up the losses.

The Health and Human Services Commission is recommending lower Medicaid reimbursement rates — which would cut payment by as much as 37 percent for services including basic and advanced life support — to bring Texas in line with other states, according to Executive Commissioner Charles Smith.

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The rates aren’t yet final, but already they are drawing fire from lawmakers and providers alike. Twenty-two state senators and 52 House members signed onto letters this week calling for reconsideration of the cuts they said could be “catastrophic to many Texas EMS agencies.”

The San Antonio Fire Department stands to lose an estimated $600,000 a year — roughly half the cost of operating one of its 34 full EMS ambulances — should the new rates take effect Oct. 1, as proposed, according to Deputy Fire Chief Carl Wedige.

The changes are part of a Medicaid rate review the state undertakes every few years, Smith said. To arrive at the proposed payments, the commission found rate information online for 35 other states, calculated the average cost and adjusted Texas rates accordingly.

“As we went through the review we found that … Texas’ rate of payment was considerably higher than the mean and the median,” Smith told the House Human Services Committee on Wednesday. “This recommendation was to get us back in line for what other Medicaid states were paying.”

Lawmakers, however, questioned the validity of comparing Texas to other states as a way to set Medicaid rates.

Some pointed to a years-old state report that many now consider flawed, but that at the time led to dramatic cuts to a Medicaid therapy program for disabled children. During the special session, the House voted unanimously to reverse those reductions.

EMS providers said the rate review should have taken into account factors such as geography, demographics and population density that set Texas apart from other states.

“There may be one or two states in the country that could compare to us geographically as far as vastness,” said Jonathan Sell of Booker EMS, who told the committee his average transport distance is 112 miles. “The state as a whole is really not comparable to most of the states that we are comparing these rates to.”

As it stands now, state Medicaid reimbursements don’t cover the full cost of treating and transporting patients to the emergency room, EMS providers said. San Antonio recoups only about 60 percent of its costs and the city is forced to cover the shortfall, Wedige said.

Since the rate changes were unveiled, Rep. Gene Wu, D-Houston, said he has been flooded with letters from providers worried about having to reduce the number of ambulances they have in service.

“Given how massive Houston is, reducing it by a couple of vehicles could mean that your trip to the hospital, instead of being 10 to 15 minutes, is now 30 minutes. And that could be someone’s life,” Wu said.

Overall, nine of the rates for ground ambulance services would drop, one would increase and eight would not change, according to commission documents. Reimbursement for basic life support during emergency transport would decrease from roughly $240 to $158 under the proposal.

While some of the recommended rate changes were based on an average of costs in 34 states, others were calculated using data from as few as five, commission documents show.

HHSC is proposing to lower the Texas Medicaid reimbursement for “routine disposable supplies” by nearly 40 percent, based an average of rates paid in Wyoming, Wisconsin, Iowa, Arkansas and Alabama, the documents show.

For the review, the commission drew from Medicaid rates that were publicly available, according to a spokeswoman. Fourteen states, including New York, New Mexico and Kansas, were not included in the analysis.

Smith said the commission will take into account public feedback before finalizing the rates, which are set to take effect in less than three months.

“We will do an across-the-board effort in trying to make the rates livable and manageable,” he said.